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September 8, 2025 15 mins
While never ending policy debates about the mental health and homelessness crisis in the Subway persist, our guest is on the front lines every day with solutions that work. Melissa O’Brien is Medical Director of Psychiatric Services at Project Renewal, one of New York City’s largest providers of comprehensive health services to homeless individuals. We’ll talk about what she sees on the ground and what gets in the way of getting people the help they need.
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Episode Transcript

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Speaker 1 (00:01):
Welcome to Get connected with Nina del Rio, a weekly
conversation about fitness, health and happenings in our community on
one oh six point seven Light FM.

Speaker 2 (00:12):
Thanks for listening to get connected. While everyone is debating
policy around the mental health and homelessness crisis in the subway,
our guest is on the front lines every day with
solutions that work. Melissa O'Brien is medical director of psychiatric
services at Project Renewal, one of New York City's largest
providers of comprehensive health services to homeless individuals. We will

(00:33):
talk about what she sees on the ground and what
gets in the way of people getting the help they need.
Melissa O'Brien, thank you for joining me today.

Speaker 3 (00:40):
Thank you for having me.

Speaker 2 (00:41):
Melissa O'Brien leads a twenty person team providing mental health
care to New York City's homeless population and develops policies
across housing, shelter, health, and substance use programs. You can
find out more about Project Renewal at Project Renewal dot org.
And we're in this point now, meliss where there are
record numbers of people who are experiencing homelessness. They are

(01:04):
a lot of them mentally ill. According to the New
York City Comptroller's Office, about two thousand people with serious
mental illness are cycling through the streets and then subways,
in jail and hospitals, and then they start the whole
process again. Just to start with, from a wide lens perspective,
how long have you been doing this and what have
you been seeing?

Speaker 3 (01:25):
So I've been working at Project Renewal and for about
ten years now, so this is my tenth year with them,
and I've been a psychiatric nurse practitioner with them for
that amount of time too, So I've been working in
the shelter system, supportive housing, transitional housing, and safe havens
for most of that time. And you can really see

(01:46):
how mental illness impacts our patients on a daily basis
and impacts their ability to get housing, keep housing, and
how can we as mental health providers support them in
reaching their goals of how big housing.

Speaker 2 (02:01):
For the average person. It seems like so many people
living on the street or in the subway are mentally ill,
suffering from some sort of dementias something like that, so
many things have had to go wrong for them to
get there. I think part of this conversation is to
point out it's not just one thing exactly.

Speaker 3 (02:19):
I think there are many things that happened for folks
that one thing goes wrong, another thing goes wrong, and
then they end up in a situation that they need
help with. And I think that's where we come in
to support them. Many of them have come from a
cycle of homelessness where they maybe have were in foster care,

(02:40):
or their parents were in the shelter system, or they've
come from very low income places with and they have
a lot of social determinants of health that are really
impacting how they've been able to function and entering into

(03:00):
the cycle. It's really hard to break the cycle. And
so how do we support breaking the cycle and getting
them into some sense of stability with supports that we
have in the city.

Speaker 2 (03:13):
There's also the complication of trying to help someone with
mental health issues when they don't have a place to live.
How does that complicate treatment?

Speaker 3 (03:21):
Yeah, that definitely complicates treatment. I mean, even for us,
accessing healthcare can be really challenging, navigating those systems, making
an appointment, getting there, transportation, getting a subway card, all
of those things are hard. If you don't have a
roof over your head and somewhere you're staying every night.
Healthcare is not going to be necessarily the biggest priority

(03:43):
for you. Food and housing will be.

Speaker 2 (03:46):
Let's talk about your team and the people you work with.
What are you equipped to do and what does your
team do?

Speaker 3 (03:52):
So my team is made up of psychiatrists and psychiatric
nurse practitioners, and we are trying to give low barrier
access to mental health care. So what we do is
we embed our providers in shelters, in housing programs, transitional
and supportive, and our substance use programs to really be

(04:13):
where someone might sleep, where they might be receiving other services,
so that way there's no barrier for someone accessing psychiatric care.
We even have mental health services on our mobile medical clinics,
so that way folks on the streets or maybe are
coming for primary care can also see our psychiatrist who
is on that van.

Speaker 2 (04:31):
So what is the first step you take when you're
approaching someone, when you're assisting someone.

Speaker 3 (04:37):
A lot of what we do is trying to build
trust and build that rapport because folks maybe have been
wronged by the mental health system, maybe have been wronged
by healthcare in general, and so how can we build
trust with folks who maybe don't trust us. So a
lot of it might be an initial interaction of just saying, Hi,
how are you? How can I help you? Maybe I'm

(04:57):
not going to go into all the trauma that you've
had throughout your life in that first session that I'm
meeting with you.

Speaker 2 (05:03):
So is that first meaning something could be something like
I'm giving you toothpaste or lunch or you know, it
could be anything like that. Yeah.

Speaker 3 (05:10):
Yeah, So even so our provider who's like on our
mobile medical clinic, she will do that. She might hand
them some socks. What do you need? Do you need
to help with a phone call? Maybe your phone doesn't
have minutes on it. In our shelters, our providers may
walk around the shelter, may go into the lunch room
to have a conversation with clients and make themselves visibly available.

(05:33):
So that way, if someone is ready to talk, they
know who to go to and they know that that
person's approachable.

Speaker 2 (05:39):
What you were just saying a moment ago about people
having prior issues with the health system, can you kind
of give us an example of what that is, because
I think we hear that a lot. Why would something
be so bad that now I'm not going to accept help.

Speaker 3 (05:51):
I mean, I think we place a lot of trust
in our providers. I think even folks who are not homeless.
If your provider's not listening to you, or if they've
maybe utilized some information that you've told them in a
way that impacts you negatively, you may be less likely
to talk about those things going forward. So our folks
with serious mental illness may say some stuff to us

(06:13):
that might require a hospitalization, and that can be traumatic
for folks to have NYPD come on site, to have
interactions with ems, to then get transported to the ED,
to then get assessed in the ED, and then potentially admitted,
potentially cleared to come back into the community, And that

(06:34):
can have a real impact on someone opening up about
trauma that they've had to then potentially experience trauma going
through that system. And it doesn't traumatize everybody, but that
does it can cause some trauma for folks.

Speaker 2 (06:47):
Our guest is Melissa O'Brien. She's medical director of psychiatric
services at Project Renewal, one of the city's largest providers
of comprehensive health services to homeless individuals. You can find
out more about all that they do Project renewal dot org.
You're listening to get connected on one O six point
seven light FM. I'm Mina del Rio, So that gets
us a bit to policy. How do you feel about

(07:12):
a couple of things right now? New York State is
changing the legal standard for involuntary commitment for the mentally ill.
They're funding a pilot program to move in that direction
for people in crisis. So someone is having an incident
they don't want to go in the state could decide
for them. That's the basic, my own basic understanding of it.

(07:33):
How do you feel about that?

Speaker 3 (07:35):
So far? It hasn't changed how we've operated. We are
still using our clinical skills and our clinical assessment skills
of what's best for the client in that moment, So
it hasn't changed how we are assessing or intervening currently.

Speaker 2 (07:51):
Are you able to do you often see cases like
that or do you you know? I assume every once
in a while there's one of those.

Speaker 3 (07:57):
Yeah, we definitely have cases like that. And what we
try to do as we try to de escalate as
best we can, So we try to avoid activating ams,
calling NYPD if we can, and we try to use
all of our de escalation techniques to avoid that, and
how can we potentially provide intervention on site that could
help with treatment without using the emergency response system.

Speaker 2 (08:20):
And I would assume to some degree your job is
about creating relationships people who may not want to accept
things now, but let's have a conversation. What can we
help you with today or the next day or the
next day.

Speaker 3 (08:30):
Absolutely, we have had clients in some of our shelters
who maybe have been in the shelter system for a
very long time, so they might not be in the streets,
but they had some sort of barrier to getting housing,
and it's creating that community and that connection. I have
a nurse care manager who really connected with a client
who had been in the shelter for quite a while,

(08:52):
and through her relationship with that client, that client was
able to come see psychiatry, get on medications, was able
to follow the steps through housing, and they're currently housed
in support of housing. So just that relationship and that
building up relationship where the traditional you need to go
see psych before creating that relationship didn't work for this client,

(09:12):
and now we are able to help them get into
housing and they're coming back to see us for medication management.

Speaker 2 (09:18):
There's also a conversation now as we approach the mayor's
race and all these sorts of things. We just have
a budget passed. Of course, people are talking about different approaches.
One of the candidates is pressing for a quality of
life teams, so social workers and mental health workers to
assist police officers responding to specific calls. Your thoughts on that.

Speaker 3 (09:36):
I think that's a great idea. I think having social
work and having folks trained in mental illness and how
to de escalate situations is really beneficial as well as
they can also I'm assuming this team can help provide
with resources and referrals to get help.

Speaker 2 (09:55):
Part of the issue, of course, is housing as well.
People are so close, in so many circumstances from being homeless.
You're sleeping on someone's couch. You can't sleep on their
couch anymore, is just one little step away from being homeless.
There's a lot of people like that. Can you talk
a little bit about how the affordable housing issue or

(10:15):
what would be the most useful thing I think to
kind of help people in that situation.

Speaker 3 (10:21):
I think we need some safety nets similar to maybe
what we had during COVID for folks who were on
that verge of avoiding going into the shelter system. I
think there's potentially a lot of social services that could
be used to support folks in staying in housing that
was affordable for them, And I think resources could be

(10:42):
really helpful to avoid coming into the shelter system.

Speaker 2 (10:46):
What other systemic changes would make the biggest difference for
the people you work with your patients.

Speaker 3 (10:52):
I think having low barrier access to healthcare is really
important for our folks. Know we do here a project
renewal every day, but I also know that there's a
whole lot of other systems out there that might have
some barriers, and our folks don't fit into a traditional
box that like the traditional outpatient where it's a fifteen

(11:13):
minute appointment. Our clients don't can't function in that manner.
They need time, they need grace and being potentially late
for appointments because time is really hard for folks. If
you're living on a street corner and remembering that you
have a nine am appointment, that can be really challenging
to get to. So thinking outside of the box and
having some flexibility to really meet our clients where they

(11:36):
are emotionally, physically, all of those things I think is
going to have the biggest impact.

Speaker 2 (11:40):
And for the average person, you know, you see people
and you want to do something, but you don't really
know what to do. What would you like the average
person to understand about the people you work with and
what is there to do if there's anything to do?

Speaker 3 (11:55):
I think for the average person understanding like our patients
are or can be really sick, Like mental illness is
not something that they chose. It's not something that they're
like not trying to get treatment for. They just might
not be ready yet. And how do we support them
in being ready? And some mental illnesses some of the

(12:15):
criteria is they don't know that they have that mental illness,
so they might not know that that is that's causing
problems for them at this point. And so how can
we as a society support them in community treatment and
getting connected to care and having wrap around services that
really create safety nets to support them in their goals.

Speaker 2 (12:40):
Can you talk about someone who I'm sure there's been
a few whom you were able to assist that's been
particularly significant to you.

Speaker 3 (12:48):
Yeah, we've had some really big cases. I mean, most
of the shelters that we run and provide psychiatric services
to our ones. That folks are diagnosed with serious mental
illness substance use as well as some sort of physical
diagnosis as well. So they're really complex clients and so

(13:12):
having those breakthroughs can take a lot of time and
a lot of energy and really utilize an interdisciplinary team
to do that. And I'm thinking about a client who
maybe verbally reacted frequently with staff and could become somewhat

(13:32):
behaviorally justsregulated, never violent, but could become upset when because
they had some paranoia around and some delusions and some
stacosis where they thought people were watching them and observing them,
and so that made them feel uncomfortable like I would
fee uncomfortable too if someone I thought someone was watching me.

(13:52):
And the staff, both case management and psychiatry we were
able to help adjuster medication, developed that relationship where she
felt safe even though she was still having the paranoia.
We were able to build this relationship that even though
she had this fear, she was still able to come
to staff and talk, and then we were able to

(14:14):
adjust her medication. She was able to regulate her behaviors
a lot better and she was able, she was happier,
and then we were able to actually get her into housing.
And she still calls to update us on how she's
doing and sometimes comes back and visits.

Speaker 2 (14:33):
Oh it's fantastic.

Speaker 3 (14:34):
Yeah.

Speaker 2 (14:35):
What gives you hope in this work.

Speaker 3 (14:37):
The people, the staff and the clients and the patients
like people. It's hard work. And the folks who come
up and show up every day in the shelters, in
the housing programs, all levels. What they can do together
as a team inspires me.

Speaker 2 (14:58):
Our guest is Melissa O'Brien. She's medical director of psychiatric
services at Project Renewal. You can find out more at
Project Renewal dot org. Thank you for being on to
get Connected.

Speaker 3 (15:08):
Thank you so much for having me.

Speaker 1 (15:10):
This has been Get Connected with Nina del Rio on
one oh six point seven light Fm. The views and
opinions of our guests do not necessarily reflect the views
of the station. If you missed any part of our
show or want to share it, visit our website for
downloads and podcasts at one O six to seven lightfm
dot com. Thanks for listening.
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